Prevalence and predictors of disability 24-months after injury for hospitalised and non-hospitalised participants: results from a longitudinal cohort study in New Zealand.

INTRODUCTION: Most studies investigating disability outcomes following injury have examined hospitalised patients. It is not known whether variables associated with disability outcomes are similar for injured people who are not hospitalised. AIMS: This paper compares the prevalence of disability 24 months after injury for participants in the Prospective Outcomes of Injury Study who were hospitalised and those non-hospitalised, and also seeks to identify pre-injury and injury-related predictors of disability among hospitalised and non-hospitalised participants. METHODS: Participants, aged 18-64 years, were recruited from an injury claims register managed by New Zealand's no-fault injury compensation insurer after referral by health care professionals. A wide range of pre-injury socio-demographic, health and psychosocial characteristics were collected, as well as injury-related characteristics; outcome is assessed using the WHODAS. Multivariable models estimating relative risks of disability for hospitalised and non-hospitalised participants were developed using Poisson regression methods. RESULTS: Of 2856 participants, analyses were restricted to 2184 (76%) participants for whom both pre-injury and 24 month WHODAS data were available. Of these, 25% were hospitalised. In both hospitalised and non-hospitalised groups, 13% experience disability (WHODAS≥10) 24 months after injury; higher than pre-injury (5%). Of 28 predictor variables, seven independently placed injured participants in the hospitalised group at increased risk of disability 24 months after injury; eight in the non-hospitalised. Only four predictors (pre-injury disability, two or more pre-injury chronic conditions, pre-injury BMI≥30 and trouble accessing healthcare services) were common to both the hospitalised and non-hospitalised groups. There is some evidence to suggest that among the hospitalised group, Maori have higher risk of disability relative to non-Maori. CONCLUSIONS: At 24 months considerable disability is borne, equally, by hospitalised and non-hospitalised groups. However, predictors of disability are not necessarily consistent between the hospitalised and non-hospitalised groups, suggesting caution in generalising results from one group to the other.

Pacific peoples three months after injury: a comparison of outcomes between Pacific and non-Pacific participants in a NZ cohort study.

OBJECTIVES: To: describe pre-injury characteristics of Pacific (n=239) and non-Pacific (n=2,611) participants and compare their outcomes three months after injury. METHODS: Participants were New Zealand residents aged 18-64 years referred to the Accident Compensation Corporation's injury entitlement claims register. Univariate and multivariable analyses compared pre-injury and injury-related characteristics of Pacific and non-Pacific people and assessed the unadjusted and adjusted relative risks for selected outcomes. RESULTS: Of the 2,856 participants, 239 identified at least one Pacific ethnicity. Adjusted relative risks (aRR; 95% confidence intervals) for Pacific peoples, with the non-Pacific group as the reference, indicate Pacific peoples were: less likely to have no/lesser problems with disability (aRR=0.82; 0.70,0.95); less likely to have no problems with EQ-5D self-care (aRR=0.88; 0.80,0.98); less likely not to report EQ-5D anxiety/depression (aRR=0.84; 0.76,0.93); and less satisfied with social relationships three months after injury (aRR=0.89; 0.83,0.95). CONCLUSIONS: Evidence does not suggest Pacific peoples' likelihood of paid employment differs from non-Pacific people three months after injury. However, Pacific peoples appear to have an increased likelihood of problems with disability, self-care, anxiety/depression and social relationships. IMPLICATIONS: This study provides information about a range of previously unknown outcomes following injury for Pacific peoples in New Zealand, and suggests areas of possible focus for health and rehabilitation service providers and policy-makers interested in improving outcomes for injured Pacific peoples.

Community experience of a Pacific Immersion Programme for medical students in New Zealand.

AIM: To obtain the views of the Pacific community about their involvement in a Pacific Immersion Programme, to determine the programme's viability as a resource for medical education. METHOD: The Pacific Immersion Programme run by the Dunedin School of Medicine had four attachments (March, April, June and September) with local Pacific communities in 2011. Community focus groups were held the week immediately after each attachment. There were two focus group sessions for each attachment, one obtained the views of adults and the other of young people. Focus groups consisted of eight participants recruited through community coordinators and were facilitated by trained research assistants. Sessions were audio recorded and analysed using a thematic framework. RESULTS: Sixty-four members of the community participated in the focus groups. Eight themes emerged from the discussions. The community agreed the Pacific Immersion Programme strengthened community cohesion through efforts to engage the students. There was shared learning and created opportunities for engagement between medical students and the community's younger generation. The Pacific families shared with the students about their health and context through storytelling, dancing and singing and cultural ceremonies. Participants hoped students achieved what they wanted from the programme and the experience was useful for their work in the future. CONCLUSION: Community based medical education is a unique and useful approach for teaching medical students about the health of a minority community. The purpose of the paper is to highlight the impacts on participating communities. Nurturing established relationships and providing mutual benefits for both partners will ensure this opportunity will be available as a learning resource for future medical students.